| 摘要: | 近年來中醫在西方國家越來越普及化，並有越來越多的患者會尋求中醫治療，即便中醫是由針灸和中藥所共同構成，但是兩者分別為不同的系統，在亞洲國家如台灣，中藥醫療比針灸治療的施行率高出很多，而在大多西方國家中則是相反，亦此，在西方對於中醫的管理與亞洲有些許不同，其中包含了一些藥物的使用限制，不過至於這是否為造成施行率不同的原因或是其結果則尚不可知。在亞洲國家如台灣，中藥醫療比針灸治療的施行率高出很多，因此，本研究的目的是估量西方的管制制度對西方的中藥醫療影響。
本研究調查六個國家的管制政策，其中包含美國，德國，加拿大，英國，澳洲和以色列，並收集所有禁用的中藥以及相關的條件，以分析禁用藥材對中藥醫療的影響。所有的藥材依據全民健康保險資料庫裡的開方比率進行排序。自從一九九五年以來，台灣的全民健保納入了中藥醫療和濃縮科學中藥的使用記錄，因此可以分析中醫師開的處方。被分析的數據中包括200萬名從兩千年到二零一一年所隨機選取患者的中醫處方，並依據分析的結果，把所有的單方按照開方比例排列，然後與上述的禁用藥材名單合并。
分析結果發現，六個國家中禁用的藥材數以美國最少（僅禁用六味），而以加拿大最多（禁用九十味）。在台灣最常用的二十五味藥材當中，只有麻黃被所有的國家禁用。在各國中，大多數被禁用的藥材，不在常用的前一百名內。
本研究為首篇使用大規模數據分析中藥材使用次數，並清楚說明此六國關於中藥的管制法令，且詳細地列出各國禁用之中藥材的文章。希望本論文能提供各國作為中藥管制的參考。
Chinese Medicine (CM) is already widely used in the West, and is growingly popular amongst patients seeking treatment for various ailments. Although grouped under the same framework, acupuncture and Chinese Herbal Medicine (CHM) are two different modalities within this system. While in places like Taiwan, CHM is more commonly used than acupuncture, it seems that in the West things are reversed. Whether as a consequence, or as a contributing factor, the regulation of CHM in the West is different than in Asia, with several substances being prohibited. This study sought to assess the impact of the regulations on the range of substances CHM practitioners are allowed to prescribe.
For this purpose, the regulatory systems of six countries were surveyed: USA, Germany, Canada, UK, Australia and Israel. A list of all the allowed and prohibited Chinese Materia Medicine (CMM) in each country was compiled, along with any relevant stipulations. In order to evaluate the impact of banning a certain CMM on the ability of practitioners to prescribe formulas, CMM were ranked through data from the Taiwanese National Health Insurance Research Database (NHIRD). As CM is reimbursed by the Taiwanese NHI since 1995, patients may therefore receive concentrated-herbal-granules as part of CHM therapy. The NHIRD data analyzed was that of 2,000,000 randomly selected patients CHM prescriptions, from the years 2000-2011. From these results, the top 300 most frequently used CMM in the NHIRD were then compared to the banned substances from each country.
It was found that of the country with the least banned substances was the USA, with 6. The country with the most banned substances was Canada, with 90, followed by Israel with 64. The amount of prohibited CMM in the rest of the countries varied between these two margins. Ma huang (麻黃, Ephedra sinica) was the only CMM ranked within the top #25 most-frequently-used in Taiwan to be restricted in all six countries. The majority of prohibited substances in the various countries were ranked below #100 in their frequency of use.
This study is the first to address regulations of CHM in this manner, and is the first clear accessible material to list CMM banned in these six countries. In addition, it is the first time the frequency of use of CMM has been ranked in an explicit manner from data of this scale. This paper might serve regulators as a reference in the process of regulating CHM in the various countries. |
